Kim, Katie Y.

Kim, Katie Y. is an individual health care provider with primary practice located at 1199 N E St , San Bernardino CA 92410-3507. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Kim, Katie Y. can be contacted via phone (909) 381-6507.

Contact Information

Primary practice address
1199 N E St San Bernardino CA 92410-3507
Phone: (909) 381-6507
Fax: (909) 381-9517
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 54464 California

Profile Details

NPI number 1336288893
LBN Legal business name Kim, Katie Y.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 5th, 2007
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336288893 NPPES
California MEDICAID D54464

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